In 1979 Jean Pierre Angelchick developed a doughnut-like prosthesis made of nylon and filled with silicone gel. He assumed that the device, when placed around the distal esophagus, would prevent GERD by reinforcing the lower esophageal sphincter, LES. Around 30,000 devices were implanted around the world before the Angelchick band was discontinued. The Angelchick device caused dysphagia, erosion and most importantly, it failed to control reflux.
Gastroesophageal reflux disease is a complex multifactorial problem. Our understanding of GERD pathophysiology is still limited. The human mind tends to find and adopt common sense explanations and solutions for complex problems. GERD is a perfect example. Dr. Jean Pierre Angelchick assumed that GERD results from a weak lower esophageal sphincter and sphincter augmentation by a compression device applied externally to the lower esophagus would fix the problem. The lower esophageal sphincter is only one component of a complex structure called the gastro-esophageal junction, GEJ. GEJ is a dynamic structure responding to a myriad of factors like esophageal contractions and gastric fundus relaxation and distention. Lower esophageal sphincter relaxation by itself does not lead to GEJ opening. Esophageal shortening, crural diaphragm inhibition and a positive pressure gradient between stomach and esophagus are also needed. Furthermore, GEJ opening during transient lower esophageal sphincter relaxation (TLESR) events, is only occasionally associated with pH evidence for reflux. In addition, not all reflux events are considered pathologic. “Physiologic” reflux does occur and is considered part of a normal GEJ function. Consequently, other mechanisms, besides TLESR, are at play in GERD pathophysiology. Of course, closing the GEJ will obviously stop reflux completely and by the same mechanism prevent swallowing. The trick to GERD management is restoring the one-way valve at the GEJ that allows for food passage into the stomach while preventing reflux. This is perfectly achieved using the short and floppy Nissen fundoplication. A properly performed 360 degree wrap does not mechanically narrow the distal esophagus. Rather, the newly positioned gastric fundus decreases the incidence of GEJ opening following TLESR events. A floppy Nissen wrap is a physiologic valve rather than a fixed mechanical esophageal constriction. It responds to gastric pressure increases and maintains a positive pressure gradient between the intra-abdominal esophagus and gastric lumen preventing backflow of gastric content and GEJ opening. At the same time, esophageal motility and food bolus passage from the esophagus into the stomach is unhampered. The end result is reflux control without impeding esophageal motility.
Today, there is no other alternative solution that matches the Nissen fundoplication in its efficacy in controlling GERD. Houston Heartburn and Reflux Center is proud to offer the safest, and most effective treatments for GERD.